Lactic acidosis secondary to metformin overdose: A case report

被引：11

作者：

Simon Timbrell

Gary Wilbourn

James Harper

Alan Liddle

机构：

[1] Intensive Care Unit, Lincoln County Hospital, Lincoln

[2] Queens Medical Centre, Nottingham University Medical School, Nottingham

来源：

Journal of Medical Case Reports | / 6卷 / 1期

关键词：

Metformin; Lactate Level; Lactic Acidosis; Arterial Lactate; Critical Care Patient;

D O I：

10.1186/1752-1947-6-230

中图分类号：

学科分类号：

摘要：

Introduction. Metformin is a commonly used treatment modality in type 2 diabetes mellitus, with a well documented side effect of lactic acidosis. In the intensive care setting lactate and pH levels are regularly used as a useful predictor of poor prognosis. In this article we highlight how high lactate levels are not an accurate predictor of mortality in deliberate metformin overdose. Case presentation. We present the case of a 70-year-old Caucasian man who took a deliberate metformin overdose of unknown quantity. He had a profound lactic acidosis at presentation with a pH of 6.93 and a lactate level of more than 20mmol/L. These figures would normally correspond with a mortality of more than 80%; however, with appropriate management this patients condition improved. Conclusion: We provide evidence that the decision to treat severe lactic acidosis in deliberate metformin overdose should not be based on arterial lactate and pH levels, as would be the case in other overdoses. We also demonstrate that appropriate treatment with hemodiafiltration and 8.4% sodium bicarbonate, even in patients with a very high lactate and low pH, can be successful. © 2012 Timbrell et al.; licensee BioMed Central Ltd.

引用

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